Does The Lady Health Workers Programme Need An Update?

Thirty years on, does the Lady Health Workers programme need reform or does it need to go back to basics?

As we near the 30th anniversary of the Lady Health Workers' Programme (LHWP), the latest episode in think tank Tabadlab's Islahati Jaiza series delves extensively into the evolution of the programme and its foundational value of providing primary healthcare services at the doorstep. 

Former MNA and development policy specialist Shahnaz Wazir Ali and Dr Zulfiqar Bhutta, Founding Director of the Institute for Global Health and Development and the Centre of
Excellence in Women and Child Health, AKU, shed light on the conception of the LHWP in
the 1980s by the Pakistan People’s Party after enduring 11 years of military dictatorship.

This pioneering programme sought to move away from a "fixed facility-based healthcare system" and aimed to achieve Universal Health Coverage. Public Health Researcher Dr Adnan Khan underscores that the inception and implementation of the programme were driven by a low contraceptive prevalence rate.

Consequently, the LHWP's core mission was centered around family planning and mother-child health, resulting in a remarkable 13% increase in contraception usage within eight years of programme implementation. 

Over the years, and particularly post the 18th amendment, the scope of the LHWP expanded, 
encountering numerous challenges. Despite inconsistencies and changes in governance, the program has endured the test of time.

This episode raises critical questions: What are the challenges faced by the LHWP, and how do they differ among provinces? Is it time for the program to refocus on its core mission of family planning and maternal-child health? Is it high time to amend the programme policy and design according to the varying provincial needs? What are some of the possible interventions to address the structural flaws for better implementation of the programme? 

What is Islahati Jaiza? 

As the country grapples with polycrisis, Tabadlab engages with experts to analyse reform efforts that have previously been enacted to address the country’s challenges. By understanding the successes and shortfalls of these policies, programs, and institutions, the Islahati Jaiza series will bring to light important insights about reforms in Pakistani public policy. 

In each episode, panelists draw on years of expertise to trace reforms in a particular sector (and in some cases, particular jurisdictions), to try to unpack their impact, and chart a path forward. 

The inaugural episode of Islahati Jaiza focused on the past two decades of reform in the education sector in the Punjab, explaining how Punjab gained the momentum and success it did in that area. 

Pakistan is in urgent need of a comprehensive reform agenda to address its longstanding challenges and meet the needs of the future amidst shifting technologies and the ever- growing threat of climate change. Tabadlab’s Islahati Jaiza is an effort to explore reforms attempted in the recent past, to help inform future policy.